Mental Health Consequences of HIV- A Gender Perspective Ravi Paul 1, J.Anitha Menon 1, Mary S Ngoma 1 Knut A. Hestad 2, 1 University of Zambia 2 Norwegian University of Science and Technology

Introduction HIV and AIDS scenario in Zambia In 2009, an estimated 14.3 per cent of Zambia’s 12.9 million population was infected with HIV, and Zambia is seventh among the countries worst affected by this epidemic (National AIDS Council, 2010). The country’s first reported AIDS diagnosis was in 1984, and this was followed by a rapid rise in estimates of HIV prevalence (Zambian Ministry of Health and Central Board of Health, 2005).

Women and HIV HIV prevalence among Zambian women is three times as high as in males : –enforcement of laws regarding property ownership, –inheritance –marriage and sexual negotiations with their husband. Cultural practices: e.g. sexual cleansing (kusalazya) and wife inheritance (kunjilila mung’anda) make women more vulnerable to HIV

Psychosocial consequences of HIV in Women Stigmatization, divorce or abandonment Psychosocial Stressors: guilt of not sharing their status, depression and the trauma of knowing they are positive Antiretroviral drugs Gender violence, physical and sexual abuse

Effect of HIV on CNS HIV enters the central nervous system (CNS) early after infection and eventually results in both structural and functional brain changes in about 30-50% of cases (Shaw et al. 1985). These changes may have significant effects on day-to-day functioning (Antinori et al., 2007).

HIV and Cognitive Impairment Prevalence of milder cognitive impairment may be increasing as HIV+ people are living longer due to modern antiretroviral therapy (Heaton et al., 2011). Individuals infected with clade C may be at risk of developing HIV Associated Neurocognitive Disorders (HAND) (Joska et al., 2010; Yepthomi et al., 2006).

Research evidence from Zambia Examined neuropsychological differences, especially gender difference, between HIV seropostive (HIV+) patients being followed in a University of Zambia clinic and demographically comparable seronegative (HIV-) controls recruited in the same setting. Sample: 38 individuals who tested HIV+ and 42 who were tested HIV- Recruited from the University of Zambia anti- retroviral therapy (ART) clinic in consultation with the medical officer Inclusion criteria: a minimum of 8 years of education, in the age range of 20 years to 40 years, have no known risk for neurological impairment other than HIV infection, and no history of alcohol or drug abuse

Results Difference between HIV+ and HIV- in areas of: –s–speed of information processing –v–verbal fluency –e–executive functioning and –v–visual episodic memory Difference seen between HIV+ and HIV –cohorts was primarily due to the HIVseropositive females Ref: Hestad, Menon et al. (2012) Sex Differences in Neuropsychological Performance as an Effect of Human Immunodeficiency Virus Infection- A Pilot Study in Zambia, Africa. Journal of Nervous and Mental Disease

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